Perioperative considerations in the management of a patient with coronary artery disease undergoing noncardiac surgery

1. If the surgery is elective or less urgent and the cardiac disease is of such a magnitude that surgical correction is indicated, then it is preferable to perform the cardiac surgery [or some relevant interventional procedure such as percutaneous transluminal coronary angioplasty (PTCA) for coronary artery disease (CAD) or balloon mitral vlvotomy (BMV) for mitral stenosis (MS)] before noncardiac surgery is attempted. Alternately, if the cardiac disease does not warrant surgical correction, then the medical management should be optimised before subjecting the patient to noncardiac surgery. 2. If the surgery is of emergent nature and does not allow sufficient time for the treatment of cardiac lesion, then surgery should be undertaken with an elevated or low risk. This stratification should be decided after preoperative evaluation. However, an attempt should be made to optimize the cardiac condition by medical management (such as diuretics, inotropes, dilators) or mechanical ABSTRACT